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A 76yoF PMHx CHF, HTN is admitted with AMS and mild upper
respiratory sxs. According to family, her mental status gradually declined
over the last 3 days. Because generalized weakness and upper
respiratory sxs, limited amount of food/drink in the last 72hrs. Home
meds: metoprolol, lisinopril, furosemide. Family states she's compliant.
Vitals: HR 118, BP 96/53, RR 14, SpO2 98% RA
Dry mucous membranes, poor skin turgor, absence of JVD. Clear on
auscultation. Opens eyes to voice, mumbles incomprehensible sounds,
generalized weakness. 2 minute tonic-clonic seizure in ED which
resolves without intervention.
,Na 110, K 4.5, Cl 80, Bicarb 26, BUN 57, Cr 1.2, glucose 89.
Most appropriate next step?
A) free water restriction
B) hypertonic (3%) saline, 100mL for rapid early correction, goal serum
Na 118 in 24 hrs
C) Normal saline bolus, 1L over 10 min, repeat for goal serum Na 128 in
24hrs
D) oral tolvaptan, 15mg - ANSWER ✔✔B) Hypertonic (3%) saline,
100 mL for rapid early correction, with goal serum sodium of 118 mEq/L
in 24 hours
A 72yoF PMHx HTN, T2DM, smoking develops sudden-onset severe CP
associated with difficulty breathing and diaphoresis.
Vitals on arrival in ED: BP 165/92, HR 101, RR 29, SpO2 96% RA.
Which of the following ECG findings is most significant indicator for
immediate reperfusion in this patient?
A) ST segment depression
B) ST segment elevation
C) T wave inversions
, D) Peaked T waves - ANSWER ✔✔B) ST segment elevation
A 72yoM presents to ED with CHF exacerbation. Awake and alert but in
distress. Using accessory respiratory muscles and says it's hard to
breathe.
Vitals: HR 120, BP 120/80, RR 34, SpO2 90% on 8L simple face maks.
PE: bilateral lower extremity edema, crackles in posterior lung fields.
CXR: bilateral fluffy infiltrates consistent with pulmonary edema
ABG: pH 7.3, PCO2 50, PO2 64
In addition to diuresis, which of the following is the best next step in this
patient's management?
A) intubate and initiate invasive mechanical ventilation
B) initiate noninvasive positive pressure ventilation
C) switch to nonrebreather oxygen mask
D) switch to high-flow, high-humidity oxygen - ANSWER ✔✔B) initiate
noninvasive positive pressure ventilation
A 27yoM admitted to ICU with SAH after MVC. Initial GCS 8 with labored
respirations. He was intubated in the ED and placed on a ventilator.
Shortly after arrival to the unit, SpO2 reads 57% with HR 46 and no
pulse.
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